后路一期病灶清除椎弓根钉内固定术治疗胸椎结核

目的探讨后路一期病灶清除椎弓根钉内固定术治疗胸椎结核的疗效。方法 2006年1月—2010年1月采用后路一期病灶清除椎弓根钉内固定术治疗胸椎结核患者36例,其中T2～32例,T3～42例,T4～53例,T5～65例,T7～810例,T8～96例,T9～104例,T11～124例。术前Frankel分级,B级5例,C级21例,D级10例。术前脊柱后凸Cobb角为11.25～48.32°,平均35.34°。结果术后随访时间12～38个月,平均16个月。所有患者均治愈,未出现复发。术后患者Frankel分级明显改善。所有植骨均达到骨性融合,椎弓根钉固定在位,无松动、塌陷及断裂。术后后凸畸形纠正0.89～27.63°,平均16.20°,随访1年未见明显丢失。结论后路一期病灶清除椎弓根钉内固定术能够一期完全清除结核病灶,脊髓减压,矫正后凸畸形、重建脊柱稳定性,是治疗胸椎结核安全有效方法。

One stage posterior surgical treatment of tuberculosis of thoracic spine by focus clearance,internal fixation by pedicle screw

Objective To investigate the clinical efficacy of one stage posterior surgical treatment of tuberculosis of thoracic spine by focus clearance,internal fixation by pedicle screw.Methods A total of 36 cases with tuberculosis of thoracic spine between Jan 2006 and Jan 2010 were treated by one stage posterior surgical treatment of tuberculosis of thoracic Spine by focus clearance,internal fixation by pedicle screw.Of these,2 cases had lesion at T2-T3,2 at T3-T4,3 at T4-T5,5 at T5-T6,10 at T7-T8,6 at T8-T9,4 at T9-T10,and4 at T11-T12.According to the Frankel scale system,5 were in grade B,21 in grade C and 10 in grade D before surgery.The average preoperative Cobb angle was 35.3°(range 18.2~58.3).Results All cases were followed up for 12-38months(average 16months).All patients were cured,and no recurrence of tuberculosis was noted.There were no internal fixation 1oosened or broken.All cases obtained noticeable improvement in neural function.The average Cobb angle was corrected to 16.2°(range11.3°-27.6°) after surgery,but no significant angles were lost in the last year.Conclusion One stage posterior surgical treatment of tuberculosis of thoracic Spine by focus clearance,internal fixation by pedicle screw is safe and effective.